Clifton Springs Hospital and Clinic
2 Coulter Road, Clifton Springs, NY · Rochesterregional · · NPI 1366505463
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Augmentation cheek bone CPT 21270 | not published | not published | $553.03 – $839.88 | 2 |
| Augmentation lower jaw bone CPT 21125 | not published | not published | $501.28 – $786.43 | 2 |
| Augmentation lower jaw bone CPT 21127 | not published | not published | $575.98 – $900.69 | 2 |
| Augmentation of facial bones CPT 21208 | not published | not published | $554.65 – $864.88 | 2 |
| Augumentation percutaneous vertebral inc cavity creation ea addl thoracic/lumbar vertebral body CPT 22515 | not published | not published | $154.45 – $248.85 | 2 |
| Augumentation percutaneous vertebral including cavity creation 1 vertebral body thoracic CPT 22513 | not published | not published | $371.55 – $578.50 | 2 |
| Autgrft implnt knee w/scope CPT 29866 | not published | not published | $799.07 – $1,170.09 | 2 |
| Autochondrocyte implant knee CPT 27412 | not published | not published | $1,219.40 – $1,826.12 | 2 |
| Autoimmune rheumatoid arthr anl 12 mrk ia CPT 81490 | $1,863.67 | $2,867.18 | $357.91 – $1,008.78 | 8 |
| Autologous blood op salvage CPT 86891 | not published | not published | $23.74 – $23.74 | 1 |
| Autologous blood process CPT 86890 | $489.81 | $753.56 | $44.08 – $44.08 | 1 |
| Autolog prp diab wound ulcer HCPCS G0465 | not published | not published | $69.99 – $140.97 | 2 |
| Autolog prp not diab ulcer HCPCS G0460 | not published | not published | $168.41 – $168.41 | 1 |
| Automated diff wbc count CPT 85004 | $23.40 | $36.00 | $3.20 – $7.76 | 10 |
| Autonomic nrv adrenrg inervj CPT 95922 | not published | not published | $37.04 – $59.25 | 3 |
| Autonomic nrv parasym inervj CPT 95921 | not published | not published | $35.26 – $44.83 | 3 |
| Autonomic nrv syst funj test CPT 95923 | not published | not published | $64.33 – $99.30 | 3 |
| Autopsy (necropsy) complete CPT 88020 | $3,801.14 | $5,847.91 | not published | 0 |
| Autopsy (necropsy) complete CPT 88025 | $4,561.15 | $7,017.15 | $266.37 – $266.37 | 1 |
| Autopsy (necropsy) complete CPT 88029 | $2,736.68 | $4,210.28 | not published | 0 |
| Avelumab 20 mg/ml intravenous solution HCPCS J9023 | not published | not published | $97.14 – $108.64 | 4 |
| Av fistula revision CPT 36833 | $9,246.97 | $14,226.11 | $596.41 – $899.48 | 2 |
| Av fuse uppr arm basilic CPT 36819 | not published | not published | $537.35 – $809.64 | 2 |
| Av fuse uppr arm cephalic CPT 36818 | $9,246.97 | $14,226.11 | $509.28 – $768.40 | 2 |
| Av fusion direct any site CPT 36821 | not published | not published | $486.65 – $735.57 | 2 |
| Av fusion/forearm vein 36820 CPT 36820 | not published | not published | $537.53 – $812.40 | 2 |
| Avul nail plate addl CPT 11732 | $236.70 | $364.15 | $12.60 – $20.25 | 2 |
| Avulsion nail plate partial/complete simple single nail plate CPT 11730 | $444.52 | $683.87 | $40.74 – $62.45 | 2 |
| Axatilimab-csfr 22 mg/0.44ml soln 0.44 ml vial HCPCS J9038 | not published | not published | $55.65 – $56.46 | 2 |
| Axicabtagene ciloleucel car+ HCPCS Q2041 | not published | not published | $532,192.24 – $562,500.89 | 2 |
| Axillary crutch extension HCPCS L0978 | not published | not published | $221.20 – $221.20 | 5 |
| Axillary lymphadenect/superficial 38740 CPT 38740 | not published | not published | $546.38 – $771.70 | 2 |
| Azacitidine injection HCPCS J9025 | not published | not published | $0.32 – $1.54 | 4 |
| Azathioprine 50 mg tablet HCPCS J7500 | not published | not published | $0.06 – $3.77 | 4 |
| Azathioprine parenteral HCPCS J7501 | not published | not published | $196.80 – $300.00 | 3 |
| Azithromycin 500 mg intravenous solution HCPCS J0456 | not published | not published | $1.89 – $5.82 | 4 |
| Azithromycin dihydrate, oral HCPCS Q0144 | $3.07 | $4.72 | $23.71 – $29.13 | 3 |
| Aztreonam 1 gram solution for injection HCPCS J0457 | not published | not published | $2.23 – $2.48 | 3 |
| Baclofen 2,000 mcg/ml intrathecal solution (wrapper) HCPCS J0475 | $338.83 | $521.28 | $174.80 – $186.92 | 4 |
| Baclofen 50 mcg/ml intrathecal solution (wrapper) HCPCS J0476 | not published | not published | $39.56 – $59.51 | 4 |
| Baclofen eval charges CPT 97750 | $106.11 | $163.25 | $28.14 – $28.94 | 3 |
| Bacterial meningitis antigen CPT 86403 | $36.88 | $56.74 | $3.79 – $13.85 | 10 |
| Bacterial vaginosis pcr CPT 87801 | $254.02 | $390.80 | $20.87 – $90.90 | 10 |
| Bactericidal level serum CPT 87197 | not published | not published | $10.01 – $18.02 | 8 |
| #bac vag cand-c. albicans naa CPT 87481 | $84.68 | $130.27 | $20.87 – $47.36 | 10 |
| Bag urine leg fbrc strap 32oz flipflo anti-reflux valve HCPCS A4358 | not published | not published | $8.94 – $8.94 | 5 |
| Balance and Coordination Retraining (each 15 minutes) CPT 97112 | $108.48 | $166.90 | $16.19 – $29.30 | 4 |
| Balloon dilate urtrl strix CPT 50706 | not published | not published | $129.31 – $210.12 | 2 |
| Banding pulmonary artery CPT 33690 | not published | not published | $937.29 – $1,329.09 | 2 |
| Barium Enema (Colon X-ray, barium and air) CPT 74280 | $336.54 | $517.76 | $125.39 – $195.02 | 3 |
| Barium Enema (Colon X-ray, barium only) CPT 74270 | $336.54 | $517.76 | $82.01 – $125.90 | 3 |
| Barium Swallow (Esophagus X-ray) CPT 74220 | $336.54 | $517.76 | $54.23 – $75.36 | 3 |
| Barrier film 1.0ml wipe HCPCS A5120 | not published | not published | $0.20 – $0.33 | 6 |
| Barrier film 28ml spray no stng cavilon HCPCS A4369 | not published | not published | $3.46 – $15.35 | 6 |
| Barrier skin flat ctf 2.75in HCPCS A4408 | not published | not published | $9.38 – $14.07 | 6 |
| Barrier skin flextend 2.25in floating flang new image HCPCS A4409 | not published | not published | $6.85 – $8.84 | 6 |
| Barrier skin flxtnd ctf 3.5in flt flang 4in w/tape cut to ft HCPCS A4414 | not published | not published | $4.98 – $7.01 | 6 |
| Barrier skn ft cx ff red 2.25 ctf new image w/tape HCPCS A4407 | not published | not published | $9.22 – $12.48 | 6 |
| Bartholin gland cyst/marsupializat 56440 CPT 56440 | not published | not published | $134.36 – $191.04 | 2 |
| Bartonella dna pcr-sendout CPT 87471 | $127.02 | $195.41 | $20.87 – $42.11 | 8 |
| Bartonella dna quant CPT 87472 | not published | not published | $20.87 – $51.41 | 8 |
| Basic vestibular evaluation CPT 92540 | not published | not published | $18.57 – $36.33 | 3 |
| Basiliximab HCPCS J0480 | not published | not published | $3,308.76 – $4,955.26 | 4 |
| Battery chrgr 12 volt utah/e HCPCS L7366 | not published | not published | $876.17 – $876.17 | 5 |
| Battery chrgr six volt otto HCPCS L7362 | not published | not published | $342.09 – $342.09 | 5 |
| Battery elec/combo vad, rep HCPCS Q0496 | not published | not published | $1,801.82 – $1,801.82 | 5 |
| Battery pneum vad replacemnt HCPCS Q0503 | not published | not published | $1,562.84 – $1,562.84 | 5 |
| B cells total count CPT 86355 | $95.54 | $146.98 | $23.40 – $52.65 | 10 |
| Bcg live 50 mg intravesical suspension HCPCS J9030 | $6.25 | $9.61 | $3.14 – $3.77 | 4 |
| Bcg vaccine intravesical CPT 90586 | not published | not published | $164.92 – $188.48 | 2 |
| Bcg vaccine percut CPT 90585 | not published | not published | $164.92 – $188.48 | 2 |
| Bckdhb gene CPT 81205 | not published | not published | $57.56 – $113.99 | 8 |
| Bebtelovimab injection HCPCS M0222 | $887.52 | $1,365.41 | not published | 0 |
| Becaplermin 0.01% gel 15 gm HCPCS S0157 | not published | not published | $29.46 – $51.80 | 3 |
| Bedside drainage bag HCPCS A4357 | not published | not published | $4.47 – $13.84 | 6 |
| Behavior counsel obesity 15min medicare g0447 HCPCS G0447 | not published | not published | $22.14 – $26.91 | 2 |
| Belatacept 250 mg intravenous solution HCPCS J0485 | not published | not published | $3.88 – $4.54 | 4 |
| Belimumab 120 mg intravenous solution HCPCS J0490 | $113.98 | $175.35 | $45.60 – $58.30 | 4 |
| Below elbow myoelectronic CT HCPCS L6935 | not published | not published | $9,609.07 – $9,609.07 | 5 |
| Below elbow prosth tiss shap HCPCS L6400 | not published | not published | $3,306.33 – $3,306.33 | 5 |
| Below knee acrylic socket HCPCS L5629 | $809.82 | $1,245.88 | $518.74 – $518.74 | 5 |
| Below knee cuff suspension HCPCS L5666 | not published | not published | $96.28 – $96.28 | 5 |
| Below knee cushion socket HCPCS L5646 | not published | not published | $710.29 – $710.29 | 5 |
| Below knee flex cover system HCPCS L5962 | not published | not published | $719.60 – $719.60 | 5 |
| Below knee leather socket HCPCS L5638 | not published | not published | $716.81 – $716.81 | 5 |
| Below knee suction socket HCPCS L5647 | not published | not published | $1,019.34 – $1,019.34 | 5 |
| Below knee sus/seal sleeve HCPCS L5685 | not published | not published | $153.94 – $153.94 | 5 |
| Below knee total contact HCPCS L5637 | $704.40 | $1,083.70 | $451.24 – $451.24 | 5 |
| Below knee wood socket HCPCS L5639 | not published | not published | $1,748.62 – $1,748.62 | 5 |
| Belt ostomy lg 34-65in HCPCS A4367 | not published | not published | $7.90 – $9.75 | 6 |
| Bendamustine 100 mg intravenous powder for solution HCPCS J9033 | not published | not published | $1.24 – $35.66 | 4 |
| Bendamustine 25 mg/ml intravenous solution (belrapzo) HCPCS J9036 | not published | not published | $11.60 – $31.20 | 4 |
| Bendamustine 25 mg/ml intravenous solution (bendeka) HCPCS J9034 | not published | not published | $12.53 – $29.69 | 4 |
| Bendamustine 25 mg/ml intravenous solution (vivimusta) HCPCS J9056 | not published | not published | $27.24 – $31.99 | 3 |
| Benign lesion paring 2-4 CPT 11056 | $444.52 | $683.87 | $16.52 – $25.95 | 2 |
| Benign lesion paring 4+ CPT 11057 | $444.52 | $683.87 | $21.29 – $33.58 | 2 |
| #_benzodiazconfur CPT 80346 | $112.43 | $172.97 | $5.05 – $11.36 | 3 |
| Benztropine 1 mg/ml injection solution HCPCS J0515 | not published | not published | $13.54 – $29.38 | 4 |
| Beta 2 glycoprotein 1 antibody iga CPT 86146 | $92.10 | $141.69 | $4.19 – $30.54 | 10 |
| Beta-2 microglobulin CPT 82232 | $58.54 | $90.06 | $10.79 – $28.42 | 10 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.